Leadership ATI Proctored Focus 2022/2023

Delegation and Task Management

• RNs can teach clients but may delegate reinforcement of teaching to LPNs.
• LPNs are authorized to perform specific care tasks like tracheostomy care and suctioning.
• RNs can delegate feeding clients not on swallow precautions to APs and also the collection of urine samples.
• Delegation to assistive personnel (AP) for vital sign checks on post-op patients requiring naloxone is inappropriate due to the need for careful assessment.

Client Care Scenarios

• If an older adult on fall precautions is found on the floor, priority is to inspect for injuries before any other action.
• After surgery, RNs can assign LPNs to take vital signs of post-op clients but not to administer blood or develop care plans.
• RNs are responsible for communicating medication information to clients and families, upholding confidentiality and compliance with health policies.

Advocacy and Ethical Responsibilities

• In cases of suspected abuse, nurses must report allegations to management for investigation.
• Client advocacy includes clarifying and discussing treatment options, assisting with questions for the provider, and ensuring care aligns with living wills.
• Ethical guidelines for nurses, such as the Code of Ethics, are not legally binding but serve as a professional guide.

Quality Improvement and Performance Management

• The audit process involves structure evaluations, outcome assessments, and addressing sentinel events via root cause analyses.
• Performance appraisals for staff should include comparisons to standards and allow self-evaluation opportunities.
• High rates of healthcare-associated infections (HAIs) should prompt immediate reviews of hand hygiene practices.

Patient Safety and Risk Management

• Advance directives are essential, and patients need guidance on their importance, even if they initially express disinterest.
• In home assessments, factors increasing fall risks include vision impairment, previous fall history, and living conditions such as wearing slippers.
• For clients post-surgery experiencing confusion and risk of dislocating joints, restraint application requires provider orders and family consent.

Interprofessional Collaboration and Care Planning

• Effective interprofessional teams include members like occupational and physical therapists, psychologists, and vocational counselors, especially for rehabilitation clients.
• During patient transfer reports, key information includes advance directive status and special equipment needs but not the type of anesthesia used.

Managing Conflicts and Team Dynamics

• Addressing team tensions should start with identifying stressors collaboratively.
• Adaptation of decision-making styles in nursing management can support team engagement and collective problem-solving.

Core Nursing Responsibilities

• Delegation should prioritize tasks appropriate to skill levels, with RNs managing medications and LPNs handling specific procedures.
• Priority patient assessments focus on those with the highest risk factors, ensuring timely interventions.
• Documentation of procedures and medication administration ensures accountability and quality in care delivery.### Nursing Actions for Medication Error
• In the event of administering an antihypertensive medication in error, begin by monitoring the client's vital signs to assess any immediate effects.
• Instruct the client to remain in bed until a provider can evaluate the situation.
• Contact the client’s provider to inform them of the error and receive further instructions.
• Complete an incident report that outlines the error and the actions taken in response.
• Notify the risk management department to ensure that the incident is documented and reviewed for quality improvement.

Incident Reports in Nursing

• Documenting a description of incidents in the client's healthcare record should not include sharing incident reports with the client.
• Incident reports must encompass a detailed account of both the incident and the actions that followed.
• The risk management department is responsible for investigating the incidents to ensure patient safety and compliance.

Patient Assignment for New Registered Nurses (RNs)

• New RNs should only be assigned patients with whom they are competent, and this competency must be verified by an experienced RN before patient assignment.

Tracheostomy Discharge Planning

• Always keep two extra tracheostomy tubes available: one that matches the client's size and one that is a size smaller.
• Ensure that an obturator and trach ties accompany each tube, along with sterile saline and lubricant for emergency care.

Confidentiality in Nursing Practice

• Client medical records must be stored securely, with access limited to authorized personnel only.
• Information cannot be shared with unauthorized individuals unless they provide a specific code for verification.

Preoperative Nursing Care Protocol

• Instruct family members to safeguard the client's belongings by storing them safely before any procedure.

Client Care Prioritization

• Apply the prioritization hierarchy: systemic issues before local ones, acute situations before chronic conditions, and actual problems before potential ones.
• Recognize trends in client health rather than assume findings; identify emergencies and complications through careful assessment.

Ethical Principles in Nursing

• Adhere to ethical responsibilities including justice (fairness), beneficence (acting in patient’s best interest), nonmaleficence (doing no harm), fidelity (keeping promises), autonomy (respecting independence), and veracity (truthfulness).

Emergency Informed Consent

• Informed consent can be bypassed in emergency situations where a client is unconscious and surgery is critical for survival.

Telephone Prescription Protocol

• When receiving a telephone prescription, it is important to write the details down correctly, repeat the prescription back for verification, and document the conversation in the client’s chart.

Tort in Nursing Practice

• A tort is defined as a wrongful act or infringement of a right that causes harm or loss to another, leading to legal liability.

Performance Improvement in Client Care

• Quality improvement processes are established through policies and procedures, identifying issues via staff feedback, and analyzing current practices to improve outcomes.

Home Safety Assessment for Clients

• Conduct a thorough home safety assessment by removing tripping hazards, securing electrical cords, ensuring that steps are well-maintained, installing grab bars, utilizing non-skid mats in wet areas, and ensuring adequate lighting throughout the home.

Healing Assessment for Wounds

• Inflammation in wounds indicates that the body's immune system is actively engaged in the healing process.

Variance Reports for Financial Comparison

• Variance reports serve to compare projected budgets with actual financial outcomes, aiding in financial oversight and management.

Protocol for Anthrax Exposure

• Clients exposed to anthrax should receive prompt antibiotic treatment to prevent disease development.